2007 Mary Woodard Lasker Public Service Award

Advancements in AIDS relief and biodefense

The 2007 Mary Woodard Lasker Award for Public Service honors a scientist and public servant who engineered two major US governmental programs — the President's Emergency Plan for AIDS Relief (PEPFAR) and the strategy for defending the nation against dangerous biological agents — and who has spoken eloquently on behalf of medical science to the public, Congress, and successive Administrations. Anthony Fauci established himself as a world-class investigator before accepting the directorship of the National Institute of Allergy and Infectious Diseases (NIAID), a component of the National Institutes of Health. In addition to that role, in which he oversees an extensive research program aimed at preventing, diagnosing, and treating immune-mediated and infectious diseases, Fauci serves as a key adviser to the White House and Department of Health and Human Services on global AIDS/HIV issues and public health preparedness against natural and man-made biological threats. Fauci rose to prominence in the biomedical community and to AIDS patients through his HIV research in the early 1980s, but today, millions across the United States know him as the man who explains the science behind emerging biological hazards.

Fauci has made noteworthy contributions to basic and clinical research on infectious and immunologically based diseases. During the early 1980s, he recognized — before most investigators — that AIDS posed a major public health problem. He refocused his laboratory's efforts toward studying this illness before anyone had even identified the microbe that causes it. Twenty-five years later, Fauci is still probing the pathogenesis of HIV/AIDS and discerning how to harness the resulting knowledge to design prevention and therapeutic strategies. He has earned a place in the highest tier of the research establishment, and in 1992, he was elected to the US National Academy of Sciences.

Aid for AIDS

As director of the NIAID, a position he has held since 1984, Fauci has gone well beyond his basic duties. He has articulated problems of enormous public-health significance to the federal government and guided the design and implementation of effective policies. Foremost among these efforts has been the formulation and development — at the request of the President — of what is now known as PEPFAR, a program with the potential to save millions of lives in more than 120 countries, with a special emphasis on 15 nations in Africa, the Caribbean, and Asia that represent approximately half of the world's infections. PEPFAR aims to prevent 7 million new HIV infections, treat 2 million HIV-infected individuals with antiretroviral therapy, and care for 10 million HIV-infected individuals and AIDS orphans over a 5- to 7-year period. This $15 billion, multifaceted approach to combating the disease around the world is the largest commitment ever by any nation for an international health initiative dedicated to a single disease. In May, President Bush announced that he will reauthorize the program for another 5 years and has proposed to double the initial US pledge. The United States now leads the world in its level of support for the fight against HIV/AIDS, due in large part to Fauci's efforts.

Disarming biological threats

After the 9/11 attacks on the World Trade Center and the Pentagon, Fauci conceived a research and public-health program designed to rapidly improve countermeasures against potential bioterror agents. This plan intends to spur basic biomedical discoveries and quickly translate them into diagnostics, therapeutics, and vaccines. In addition, Fauci has played a major role in the development and implementation of Project Bioshield, whose purpose is to protect Americans against a chemical, biological, radiological, or nuclear attack. Its main goal is to provide a secure source of funds with which to guarantee purchase of effective vaccines or medications. In addition, it endeavors to accelerate the pace of relevant research and give the Food and Drug Administration powers to distribute countermeasures swiftly in an emergency.

Following the anthrax scare of 2001, Fauci became one of the most visible faces of the federal administration on bioterrorism-related issues. He calmly and logically laid out what was known about various threats and described the scientific and policy questions that remained to be answered. For example, he explained that anthrax is not spread from person to person. Without creating unnecessary panic, he told the public that an attack using biological agents was possible — and that the United States needed to prepare itself. His honest yet non-hysterical manner rallied support for national expenditures on public-health infrastructure, including vaccines.

Simultaneously, Fauci pointed out weaknesses in this nation's arsenal against potentially devastating scourges such as smallpox; in 2001, the United States had only 18 million doses of the smallpox vaccine. He implemented a plan that now has produced 400 million doses. Fauci was also influential in convincing President Bush to bolster the United States' preparedness against natural dangers such as seasonal and avian flu.

Compelling diplomacy

Fauci has dealt successfully with many US presidents and their administrations, as well as Congress: He began directing the NIAID at the end of the Reagan era, and then advised George H.W. Bush, Bill Clinton, and, most recently, George W. Bush. He has also worked with various heads of the Department of Health and Human Services and testified before Congress many times. He is widely respected by politicians and political appointees of different ideologies for concerning himself with public health rather than politics and for speaking the scientific truth. Throughout his tenure as a national adviser, he has stressed the importance of paying attention to emerging and reemerging biological menaces, whether they arise naturally or get 'help' from nefarious humans.

Fauci activated the HIV program that became US and then international policy. He engineered the United States' strategies to biological warfare, promoting a reasoned and scientific approach to a variety of domestic and international threats. This tactic has earned him first-class marks and tremendous powers of persuasion among federal administrations, scientists, and the general public. From HIV/AIDS to biodefense, he has engaged the public and propelled significant global health issues to the top of research and policy agendas in the United States and abroad.

by Evelyn Strauss

Award presentation by Harvey Fineberg

Anthony Stephen Fauci was reared in the Bensonhurst neighborhood of Brooklyn, a tightly-knit, Italian-American community. Tony, his sister Denise (who is here with her husband, Jack [Scorce]), and their parents lived in the apartment above their father's corner pharmacy. As a child, Tony excelled in his studies at parochial school and was admitted to Regis High School. This highly selective Jesuit secondary school immersed Tony in the humanities and the classics — Greek, Latin, Philosophy, and Ancient History. His teachers at Regis helped form his character, taught him to bridge the intellectual and the practical, developed in him the work ethic that is manifest to this day, and, above all, instilled in him the essential value of service to others. Tony probably entered Regis with the clarity of thought and ease of expression that mark his entire career; yet his habits of critical inquiry and intellectual integrity were surely formed and reinforced in that Ignatian setting. After the rigors of Regis, college and medical school were a comparative breeze.

At the College of the Holy Cross in Worcester, Massachusetts, Tony elected to pursue a career in medicine and took a combined course in Greek and premedical studies. To one schooled in the Jesuit custom of reconciling contradictory concepts, this is not so great a stretch as it may seem. Tony earned his medical degree at Cornell Medical School in 1966 and began his residency at New York Hospital-Cornell Medical Center. Like many considering a career in academic medicine, Tony sought an opportunity to round out his clinical training with an experience in bench research. The perfect opportunity arose at the National Institute of Allergy and Infectious Diseases, where Tony was simultaneously able to obtain fellowship training in infectious diseases. Under the tutelage of the redoubtable Sheldon Wolff, Tony discovered an aptitude for research that rivaled his satisfaction with patient care. He accepted an invitation to start his own laboratory at NIAID, to begin after returning from a year serving as chief medical resident at New York Hospital. Now, however, rather than a sojourn in science to prepare for life as an academic physician, Tony's chief residency rounded out his preparation for the pursuit of scientific discoveries that would save patients' lives.

And save lives he did. Tony Fauci's early discoveries of immunoregulatory factors led to successful treatment of previously fatal inflammatory conditions such as vasculitis and Wegener's granulomatosis. In 1980, Dr. Fauci became chief of the Laboratory of Immunoregulation at NIAID, a post he retains to this day. When the first clinical reports of what we now know as AIDS appeared in 1981, Tony presciently redirected his laboratory to focus on the immunobiology of AIDS and, once the causative agent was identified, of HIV.

One unanticipated benefit of this new direction was the opportunity it afforded Tony to meet and fall in love with Christine Grady, then a nurse in charge of caring for AIDS patients, and now a celebrated medical ethicist, Tony's wife, and mother of their three daughters. Two of their children, Jenny and Alison, are here. Megan, the middle one, is following in the family tradition of service to others — today starting her AmeriCorps service in Chicago.

When Dick Krause stepped down as director of NIAID in 1984, Jim Wyngaarden, the NIH director at the time, wisely turned to its rising star, Tony Fauci, to take the helm. In the more than 20 years since, through the NIH directorships of Bernadine Healy, Harold Varmus, and now, Elias Zerhouni, no Institute has undergone more dramatic growth and development than NIAID, and none has been marked by steadier, continuing leadership.

Throughout his career, Tony Fauci has been a prolific and influential scientist, with more than 1100 publications to his credit. His work is among the most frequently cited by other researchers. He is a member of the National Academy of Sciences and of the Institute of Medicine. He has received enough honorary degrees to paper over one of the very capacious walls in this room (including the mirrors). He is a recipient of the National Medal of Science, the George M. Kober Medal from the Association of American Physicians, its highest honor, and the Julius Richmond Medal from the Harvard School of Public Health — and these just in the last year or so. No one, as a scientist and institutional leader, has done more to set the pace and direction of the world's scientific response to HIV than Tony Fauci, the man we recognize today for yet other good and sufficient reasons.

When George Herbert Walker Bush was vice president, he requested a briefing at the NIH in order to get a better grasp of the AIDS pandemic. Jim Wyngaarden asked Dr. Fauci to organize the visit. The vice president, accompanied by Barbara Bush, spent a half day with Tony, visiting patients, seeing laboratories, and gaining new insight into the tragedy, scope, and complexity of the HIV pandemic. The vice president corresponded with Tony, invited him to dinners and meetings, and they became friends. Working with President George H. W. Bush, and with members of Congress from both parties, Tony solidified a reputation as a savvy and impartial scientist who could be an honest broker in policy deliberations. This role as trusted scientific adviser only strengthened and enlarged through the Clinton and George W. Bush administrations. Companion to presidents and confidante to Congress — one can only wonder whether this future ever entered the mind of the young Tony Fauci playing stickball in the streets of Brooklyn.

With his striking ability to synthesize, to reconcile divergent views, to think on his feet, and to express himself clearly, Tony has frequently been called by the media to speak on complicated scientific and health matters, such as AIDS, SARS, anthrax, multi-drug-resistant organisms, and pandemic influenza. If the public is informed and enlightened by Tony's direct, thoughtful, and understandable words, his scientific colleagues always appreciate Tony's remarkable ability to simplify and explain without distortion. Tony's distinctive and authentic Brooklyn cadence stands in marked contrast to the flat, colorless, practiced vowels that mark the locution of many media personalities. You can take the boy out of Brooklyn, but you cannot take Brooklyn out of the boy.

In the spring of 2002, President Bush asked Tony and HHS Secretary Tommy Thompson, along with others, to visit Africa and to scope out what more the United States could constructively do about AIDS. This was in the aftermath of the nevirapine trial in Uganda, which demonstrated how a simplified and affordable drug regimen could markedly reduce the frequency of mother-to-child transmission of HIV. After the trip, the Secretary and Josh Bolten, then deputy chief of staff for policy at the White House, asked Tony to put together a plan for a $500 million program to prevent mother-to-child transmission.

When the president heard the proposal, he liked it, but he asked for more — a really big project that would be transforming, accountable, and feasible. Tony Fauci became the principal scientific architect, working with White House and other staff, to design the most ambitious, international health program ever mounted by the United States — the President's Emergency Plan for AIDS Relief, known in the acronym-rich environment (ARE) of Washington as PEPFAR. This $15 billion program aims to prevent 7 million new HIV infections, treat 2 million infected individuals with antiretroviral therapy, and provide care for 10 million HIV-infected patients and AIDS orphans. According to an evaluation by the Institute of Medicine released this past spring, PEPFAR is off to a promising start, extending many thousands of lives that would otherwise be lost, and now needs to be more fully integrated into health care, given flexibility to meet local conditions in different countries, and made sustainable. PEPFAR presents a positive face of America to the world; it is the American international venture of which we can all be proud. As citizens who care about the well-being of others in the world and about America's place in the world, we owe a debt of gratitude to the man on whom our leaders relied to bring scientific knowledge, clinical expertise, and practical judgment to the design of this landmark program in foreign assistance and AIDS relief.

In the same State of the Union message where he announced his plan for AIDS, on the 28th of January, 2003, President Bush called for a comprehensive research and development program that would better protect the nation against the threat of bio-terrorism. As the designer of this bio-defense program, Tony Fauci understood that it would require mobilizing industry as well as universities and government agencies. Tony championed the idea that the steps to prepare against biological agents delivered by malevolent humans would simultaneously protect the public against natural threats of emerging and re-emerging infectious diseases. Signed into law in July 2004, Project Bioshield is accelerating research, development, purchase, availability, and deployment of effective countermeasures against agents of bio-terrorism. Because of the foresight, initiative, and persuasiveness of Tony Fauci, every American can rest a little easier.

Anthony Fauci is the consummate citizen-physician-scientist. Ingenious in the laboratory, he has applied his genius equally to the tasks of managing a large scientific enterprise and leading in the design of policies that save lives, protect our health, and advance America's contributions to the health and well-being of people elsewhere in the world. Guided throughout his life by a devotion to public service, it is altogether fitting that on this occasion, the Albert and Mary Lasker Foundation bestow the Mary Woodard Lasker Public Service Award on Dr. Anthony Fauci.

Anthony S. Fauci

Acceptance remarks, 2007 Lasker Awards Ceremony

Thank you for this extraordinary honor. I am truly humbled. I am a scientist and clinician, and yet I have been blessed with the unique opportunity to pursue my passion for public service at the same time that I remain engrossed in hands-on basic and clinical science and science administration. I had been at the NIH for approximately 10 years as a researcher studying host defense mechanisms against infectious diseases when the first cases of what would later become known as AIDS were first recognized in the summer of 1981. The scientific opportunities for discovery related to this new disease were seemingly unlimited, and I pursued these with intensity. Yet, deep down, I felt a constant nagging uneasiness that there was much more that I should be doing on a broader scale not only with HIV/AIDS, but with malaria, tuberculosis, and other great killers that continued to claim so many lives despite our modern-day technologies.

I was not alone in this feeling, but I was lucky. Being in Washington, DC as the director of the National Institute of Allergy and Infectious Diseases put me in the right place at the right time to pursue these interests. To my great fortune, I was given the opportunity to develop enduring relationships with members of Congress on both sides of the aisle and to interact personally with each of the last four presidents. Regardless of their range of ideologies, they all wanted scientific advice on domestic and global health issues from scientists whom they could trust to speak the truth. It has been and is an extraordinary experience. I realized early on that when you deal in the heady company of presidents, cabinet secretaries and members of Congress and are asked for advice, you must be prepared to disappoint people with the truth and risk never getting asked back into the inner circle. I accepted that concept. Science is truth, and as a scientist I told the truth and it actually worked; I kept getting asked back.

It was in this setting that President Bush asked then Secretary of HHS Tommy Thompson and me to go to sub-Saharan Africa in 2002 to report back on the AIDS situation there. When we returned, I made my best argument for the need for a comprehensive and transforming program led by the US government that was based on sound scientific and public health principles. This led to my being tasked with formulating and developing, with a lot of help from some wonderful people, the framework for what has come to be known as the President's Emergency Plan for AIDS Relief, or PEPFAR, a now highly successful program to treat, prevent and care for HIV/AIDS in 15 developing countries.

I never would have dreamed back in 1981 as a classically trained physician/scientist searching for broader meaning to my work on the pathogenic mechanisms of HIV disease and caring for individual patients that I would be given the opportunity to influence decisions by the leaders of our nation to positively impact the lives of so many people. It was an opportunity and an honor that I will cherish forever. It was a reward in and of itself, and yet there is so much more to do. To receive the Mary Woodard Lasker Award for Public Service in connection with this experience is more than anyone can ask for.

I want to close by thanking my NIH and HHS friends and colleagues who are here today to share this moment with me. I particularly recognize the former and present NIH directors who are here and who have been so supportive of me throughout the years: Jim Wyngaarden, who appointed me to my current position in 1984; my friend and former NIH Director Harold Varmus; and Elias Zerhouni, who has been a friend and colleague over the past six years. I also thank my lovely wife, Christine Grady, and my children Jenny, Megan, and Alison, who are both my anchors and the wind in my sails. Thank you all so much.